國家衛生研究院 NHRI:Item 3990099045/14153
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    题名: Association of frailty with thrombosis of hemodialysis vascular access: A prospective Taiwanese cohort study
    作者: Luo, CM;Hsieh, MY;Cheng, CH;Chen, CH;Liao, MT;Chuang, SY;Wu, CC
    贡献者: Institute of Population Health Sciences;Institute of Cellular and Systems Medicine
    摘要: RATIONALE & OBJECTIVE: Frailty, a multidimensional construct, has been associated with poor outcomes in patients receiving maintenance dialysis. This study aimed to assess the association of frailty with dialysis vascular access patency. STUDY DESIGN: Multicenter prospective cohort study. SETTING & PARTICIPANTS: This study included 761 prevalent patients receiving hemodialysis at nine centers in Taiwan as of January 2018. EXPOSURES: Performance-based frailty was defined as three of the following: unintentional weight loss, weakness, exhaustion, low physical activity, and slow gait speed. Patients were categorized as pre-frail if they had one or two of these characteristics. OUTCOMES: Rate of and time to dialysis access thrombosis. Data regarding vascular access events were collected for 30 months after enrollment, through December 31, 2020. ANALYTIC APPROACH: Logistic regression analysis was used to estimate the association of clinical characteristics with frailty. Cox proportional hazards regression analysis was used to estimate the association of frailty with vascular access thrombosis adjusted for known clinical risk factors. RESULTS: Patients' mean age was 66 years, 46% were female, and 18% had synthetic graft accesses and 82% arteriovenous fistulas. Overall, 31% were frail, 35% were pre-frail, and 34% were not frail. The frailty phenotype was associated with age, female sex, low body mass index, diabetes mellitus, and prior stroke. During a median follow-up of 731 days, 161 patients (21%) had access thrombosis events (not frail, 14%; pre-frail, 20%; frail, 30%; P<0.001). Frail patients had a higher risk of vascular access thrombosis than non-frail patients (hazard ratio, 2.31, 95% confidence interval, 1.55-3.39, P<0.001). After multivariable adjustment for age and comorbidities, frailty remained significantly associated with access thrombosis for both fistulas and grafts. LIMITATIONS: Limited generalizability and potential residual confounding. CONCLUSIONS: Frailty is associated with an increased risk of vascular access thrombosis. These findings highlight the risks of access failure experienced by frail patients receiving hemodialysis .
    日期: 2022-09
    關聯: American Journal of Kidney Diseases. 2022 Sep;80(3):353-363.e1.
    Link to: http://dx.doi.org/10.1053/j.ajkd.2021.12.017
    JIF/Ranking 2023: http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0272-6386&DestApp=IC2JCR
    Cited Times(WOS): https://www.webofscience.com/wos/woscc/full-record/WOS:000861067500009
    Cited Times(Scopus): https://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85132657637
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